Ustekinumab Is Effective for the Treatment of Chronic Antibiotic-Refractory Pouchitis
Chronic antibiotic-refractory pouchitis (CARP) occurs in up to 15% of patients with ulcerative colitis (UC) following proctocolectomy with ileal pouch–anal anastomosis (IPAA).
To investigate the effectiveness of ustekinumab in the treatment of CARP.
This was a retrospective single-center study of UC patients with an IPAA, who subsequently developed CARP and received ustekinumab with standard Crohn’s disease (CD) dosing between 2016 and 2018. Patients with CD of the pouch were excluded. Demographic, clinical, and endoscopic data were collected. Outcomes included a change in the endoscopic subscore of the Pouchitis Disease Activity Index (PDAI), change in the ulcerated surface area, clinical response, and the number of bowel movements per 24 h.
Twenty-four patients with CARP were included for analysis. Median follow-up time was 12.9 months (IQR 7.9-16). Twelve patients (50%) had a clinical response with the median number of bowel movements within 24 h decreasing from 8 (IQR, 5–12) to 6 (IQR, 5–8) P = 0.002. Thirteen patients had pouchoscopies available post-ustekinumab treatment. In these patients, the median endoscopic subscore of the PDAI decreased from 5 (IQR, 3–6) to 4 (IQR, 2–5), P = 0.016. Likewise, among these thirteen patients, nine (69%) had an ulcerated surface area > 10% before ustekinumab treatment; after treatment with ustekinumab, only four patients (31%) still had an ulcerated surface area of > 10%.
This is the largest study of ustekinumab treatment for patients with chronic antibiotic-refractory pouchitis. We found that ustekinumab therapy led to the improvement in clinical and endoscopic endpoints.
KeywordsPouchitis Ustekinumab Ileal pouch–anal anastomosis PDAI
JEO, DTR, and SRD conceived and designed the study. JEO, LG, RW, AI, KEJ, and NCK contributed to the acquisition of data. JEO, DTR, SRD, RW, RDC, AS, JP, and NH contributed to the analysis and interpretation of data. All authors were involved in drafting the article or revising it critically for important intellectual content. All authors approved the final manuscript to be submitted.
This work received no outside funding.
Compliance with ethical standards
Conflict of interest
JEO, RW, KEJ, AI, NKC, and NH have no relevant disclosures. DTR is a consultant and has received grant support from Abbvie, Merck & Co., Janssen, Takeda, and Pfizer. AS has received funding from AbbVie, Celltrion, and Takeda. JP has received grants from Takeda and Abbvie and serves as a consultant for Verastem. He was on the advisory board for Pfizer and Janssen. RDC is a consultant at Abbvie, Celgene, Janssen, Pfizer, Takeda, and UCB Pharma. SD has received grant support from Pfizer. No funding or sponsorship was received for this study or publication of this article.
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